Jeffrey A. Singer
On January 20, President Trump signed an executive order withdrawing the United States from the World Health Organization (WHO). This sets in motion a 12-month notice period during which the US will wind down funding of WHO operations. The US provides more funds to the WHO than any other participating country. From 2022 to 2023, the US provided the organization with $1.284 billion in funds. The US accounted for 22 percent of the agency’s funding in 2024.
Addressing public health issues is a legitimate function of the government. A central tenet of the liberal tradition is the harm principle, elucidated by the British philosopher John Stuart Mill. In On Liberty, Mill wrote, “The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.”
As Mill articulated, the harm principle justifies government intervention to prevent harm to others. In public health, this includes combating contagious diseases and regulating pollution.
In today’s globally interconnected society, where people and goods move rapidly worldwide, a global public health agency is legitimate and necessary. Cooperating with such an agency to reduce the spread of deadly communicable and infectious diseases that can come to our shores is putting America first. However, that agency need not be the WHO.
The WHO has done a lot of good when it has stuck to its original mission. Its immunization and surveillance program launched in 1967 helped eradicate smallpox. A recent report in The Lancet estimates that the WHO’s Expanded Program on Immunization, begun in 1974, may have saved an estimated 154 million lives over the past 50 years, the majority of which were infants. Its Global Influenza Surveillance and Response System (GISR) helps the US and other countries plan for influenza outbreaks, including preparing vaccines for future outbreaks.
Unfortunately, the WHO has expanded its mission over the years to areas that only tangentially relate to public health, such as issuing alcohol consumption and dietary guidelines. Such issues are more aptly defined as private health, i.e., matters that don’t cause harm to others.
But US public health agencies have done the same. As I have written here, US public health agencies’ mission creep has extended to include recommendations to lawmakers on gun control, physicians on how to treat pain, parents and teens on safely consuming social media, and parents on how to reduce the stress of childrearing. This mission creep is politically divisive, redirects agency resources away from legitimate functions, and causes agencies to take on too many roles, often failing to execute any of them effectively.
The WHO is also not immune to politicization. Critics, including some governments and public health experts, alleged that the WHO was overly deferential to China’s narrative about the virus, particularly in the early stages of the pandemic. They suggested that the WHO relied too heavily on China’s initial reporting, which downplayed the severity and transmissibility of the virus. The WHO initially echoed China’s claims that there was no evidence of human-to-human transmission, which it later revised. The WHO’s investigation into the origins of COVID-19 in China lacked transparency and independence, with former US Representative Brad Wenstrup alleging that the organization allowed China to influence the scope and findings of the inquiry.
While the WHO has faced criticism for politicization and mission creep, US public health agencies bear responsibility for their own shortcomings. Several public health agencies have engaged in scientific gatekeeping to suppress dissent during the COVID-19 pandemic. The Food and Drug Administration, in particular, has shown a troubling pattern of bureaucratic inertia and politicized decision-making, as seen during the pandemic and in its handling of innovative treatments. In our white paper, Drug Reformation, Michael F. Cannon and I show how the FDA stifles pharmaceutical innovation, contributes to rising health care spending, and infringes on patient autonomy and the right to self-medicate.
The FDA has maintained barriers to women obtaining over-the-counter birth control despite physician specialty organizations calling for decades for the agency to remove them. It took 14 years and a federal court order for the agency to remove obstacles to all women seeking emergency contraception. It dragged its feet for years while people died of opioid overdoses until finally letting people obtain the antidote naloxone over the counter in 2023. It is currently delaying veterans’ access to MDMA to treat post-traumatic stress disorder despite clinical research demonstrating the drug’s impressive efficacy.
During the early days of the COVID-19 pandemic, while the virus was spreading rapidly and fatalities mounted, the WHO swiftly distributed effective test kits developed abroad to people in the rest of the world while Americans waited months for the FDA to allow them to access test kits.
Over the next twelve months, should the US decide to rejoin the WHO, it should leverage its influence to insist on transparency and accountability within the organization and the agency returning to its original mission. Otherwise, the US should pursue other global public health arrangements that meet these requirements.
The Trump administration must also address mission creep, politicization, and glaring inefficiencies in US public health institutions. That includes ridding the Centers for Disease Control and Prevention of mission creep, considering the elimination of the Office of the Surgeon General, and abolishing the FDA.